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Back Problems Message Board

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Thanks for supplying additional details. Your stenosis is almost non-existent...and again, everything we say is based only on the written report. The spine specialist would just look at the images and then correlate that to what he/she finds upon physical exam, a basic neurological exam and after hearing how your symptoms impact your day to day life. Sometimes the radiologist will miss something...but I doubt that is an issue with your MRI.

You do not need epidural spinal injections, and further, I would advise that you do not let someone talk you into them.

Ten years ago pain management specialists barely existed. Today, many anesthesiologists switch over to pain management as the hours are better and it may be more lucrative. Now ESIs are recommended, and are made to sound risk-free, which is far from the truth. Any time something is injected near the spinal canal, there is a risk. The injections "can" be wonderful, but you don't want one unless it is really necessary.

Also, ESIs are not necessarily effective for pain relief. On occasion someone with a herniated disc will get enough relief from one or more injections that he can avoid a discectomy, but in my experience, that is more the exception than the rule. For many of us, there is minimal pain relief, and only for a short time.

My guess is that your pain is coming from the arthritis in the facet joints and the thickening of the ligamentum flavor...and this is not something surgery would be done to ameliorate.
These are the "wear and tear" problems that come with living.

I think the best thing you could do would be to find a good physical therapist that specializes in orthopedic issues, (and not all PTs are equal!!). Have the PT teach you the appropriate exercises to strengthen your back and core...and get in the habit of doing them faithfully. Try to maintain a normal weight, drink lots of fluids, and maintain good posture. Do not do things that abuse your spine, like rearranging furniture, lifting things that are too heavy, even just one time...etc. You may be able to keep your back from getting any worse.

But rest assured you do not need surgery and there is no indication you will need it in the near future. Of course, no crystal balls here...but nothing you show now looks bad or sends up any red flags.

At L5-S1 there is a slight disc bulge that is pressing into the thecal sac. However there is NO foraminal or central canal stenosis, so this is not a problem. I think this is what the lady on the phone was referring to.

If you can get a referral to PT from your PCP, I see no need to go to a spine specialist at this time, other than for your own peace of mind. As Chuck said, be sure it is an orthopedic spine surgeon and not a general orthopedic doc. You want one who only treats the back and spine.

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